Posttraumatic stress disorder, depression, alcohol use disorders and quality of life in adolescents

Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder among adolescents. While the effects of PTSD on quality of life (QOL) have been systematically studied with adults, research on the consequences of PTSD with adolescents has been limited. Among the other psychiatric disorders often associated with PTSD, major depression and alcohol use disorders are prevalent and have their own substantial morbidities. This study was designed to examine and compare the effects of PTSD, major depression, and alcohol use disorders on quality of life during adolescence. The subjects were 540 adolescents (ages 12-18 years old) recruited from clinical and community sources. Psychiatric disorders characterizing the sample included one or more of the three disorders studied (n = 275), other psychiatric disorders (n = 121), or no psychiatric disorders (n = 144). Analysis of covariance was utilized to determine the individual main effects and relative effects sizes of the three primary disorders on QOL variables. PTSD showed significant adverse effects on psychological, physical, and social functioning. Major depression showed a similar pattern. In contrast, alcohol use disorders primarily affected role functioning. While PTSD, major depression, and alcohol use disorders all adversely influenced adolescent QOL, the patterns of their effects differed. Remedial treatment interventions designed to restore QOL for adolescents with these disorders may need to focus on different areas for adolescents with PTSD or major depression than for adolescents with alcohol use disorders.     

Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.

A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r=.17) and peritraumatic dissociation the largest (weighted r=.35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders.

The authors compared the effectiveness of the Seeking Safety group, cognitive–behavioral treatment for substance use disorder and posttraumatic stress disorder (PTSD), to an active comparison health education group (Women’s Health Education [WHE]) within the National Institute on Drug Abuse’s Clinical Trials Network. The authors randomized 353 women to receive 12 sessions of Seeking Safety (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment 1 week and 3, 6, and 12 months posttreatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS), the PTSD Symptom Scale–Self Report (PSS-SR), and a substance use inventory (self-reported abstinence and percentage of days of use over 7 days). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively) but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline. Study results do not favor Seeking Safety over WHE as an adjunct to substance use disorder treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic stress disorder following cancer.

This study investigated the predictors of posttraumatic stress disorder (PTSD) following a diagnosis of cancer. Individuals who were recently diagnosed with 1st onset head and neck or lung malignancy (N = 82) were assessed within 1 month of diagnosis for acute stress disorder (ASD) and other psychological responses including depression; individuals were reassessed (N = 63) for PTSD 6 months following their cancer diagnosis. At the initial assessment ASD was diagnosed in 28% of participants, and 22% met criteria for PTSD at 6-months follow-up. Peritraumatic dissociative symptoms at the time of receiving one's cancer diagnosis was the sole predictor of PTSD severity at 6-months follow-up. Elevated dissociative symptoms and greater distress at the initial assessment were the best predictors of PTSD caseness at 6-months follow-up. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance in order to prevent chronic psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mice lacking the MHC class II transactivator (CIITA) show tissue-specific impairment of MHC class II expression

Meta-analysis, a quantitative research review, was conducted on 65 studies of the effect of education, exercise and/or psychosocial support (hereafter called psychoeducational care) in adults with chronic obstructive pulmonary disease (COPD). Studies ranged in publication date from 1954 to 1994. Only 34% of studies had subjects that were randomly assigned to treatment condition, and only 15% of studies had a placebo-type control group. Analyses by type of treatment showed that pulmonary rehabilitation (large muscle exercise and education plus a variety of psychosocial or behavioral interventions) had statistically significant beneficial effects on psychological well-being (d+ = 0.58, n = 13), endurance (d+ = 0.77, n = 13), functional status (d+ = 0.63, n = 8), VO2 (d+ = 0.56, n = 5), dyspnea (d+ = 0.71, n = 10), and adherence (d+ = 1.76, n = 2). A statistically significant beneficial effect of pulmonary rehabilitation was not found on Forced Expiratory Volume at 1 s. Across 7 outcomes examined, treatments including education-alone had significant beneficial effect on the accuracy of performing inhaler skills (d+ = 1.27, n = 7). Based on a very small sample of studies, a non-significant but small or medium sized effect of education-alone was evident on health care utilization (d+ = 0.26, n = 3) and on adherence to treatment regimen (d+ = 0.50, n = 2). Such results are inconclusive, suggesting that further research may be indicated. Relaxation-alone had statistically significant beneficial effects on both dyspnea (d+ = 0.91, n = 3) and psychological well-being (d+ = 0.39, n = 6). The research base has methodological weaknesses that should be rectified in future research. Nonetheless, based on the best evidence available to date, identified types of psychoeducational care have been shown to improve the functioning and well-being of adults with COPD.     

Social relationships and PTSD symptomatology in combat veterans.

The primary purpose of this study is to determine if recent combat veterans discriminate between different sources of social support, and then preliminarily investigate the relationship of social support source on posttraumatic stress disorder (PTSD) symptomatology. Participants included 83 married male combat veterans. Principal-axis factor analysis with equamax rotation observed four distinct latent factors for each source of support examined. ANOVAs were performed to determine the relationship of each source of support from the distinct latent factors on the level of PTSD. Results indicate that the level of PTSD is related to support received from a significant other, F(1, 81) = 30.36, p F(1, 81) = 8.10, p = .006, and military peers, F(1, 81) = 6.70, p = .011, but not friends, F(1, 81) = 1.79, p = .18. In general, higher levels of support from each category were associated with lower levels of PTSD in combat veterans. The results suggest that combat veterans distinguish between specific sources of social support, which may have a protective effect on the level of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic Stress Disorder Symptomatology Among Partners of Men in Treatment for Relationship Abuse.

This longitudinal study examined posttraumatic stress disorder (PTSD) symptoms among current and former female partners (N=96) of men participating in a group treatment program for partner abuse perpetrators. Female partner probable PTSD rates, obtained during time points corresponding with pretreatment, posttreatment, and 6-month follow-up for the male clients, were 52%, 34%, and 29%, respectively. Psychological abuse exposure was more strongly and uniquely associated with PTSD symptoms than was physical abuse exposure. Among psychological abuse ratings, denigration, restrictive engulfment, and dominance/intimidation behaviors evidenced the strongest associations with PTSD symptoms. Findings from this study suggest the association between psychological abuse and PTSD is complex and multidetermined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of posttraumatic distress 1 year after exposure to community violence: The importance of acute symptom severity.

In this longitudinal study of 333 primarily male, Hispanic survivors of community violence, the authors investigated the effects of 4 categories of risk factors on posttraumatic stress disorder (PTSD) symptom severity: demographic characteristics, pretraumatic psychological factors, characteristics of the trauma, and reactions to the trauma. Replicating past research, exemplars from all 4 categories predicted PTSD symptom severity at 12-month follow-up. Acute symptom severity, measured approximately 5 days posttrauma, accounted for the largest proportion of variance among all the predictors included. No other predictors remained significant after 5-day distress was included in the model. These findings suggest that the effects of several purported risk factors for chronic posttraumatic distress may already be reflected in acute distress following trauma exposure. These results bear on current conceptions of the fundamental nature of PTSD and suggest that initial distress during the immediate aftermath of the trauma may be an important target for intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of post-traumatic stress syndrome

This paper reviews different psychotherapeutic and drug treatments for Post Traumatic Stress Disorder (PTSD). Psychotherapeutic treatments have changed from the abreaction technique to more classical psychodynamic approaches and recently to cognitive and behavioral techniques. Many drugs have been used in the treatment of PTSD but most of the studies were not controlled and included very few patients. More recently, double blind controlled studies have been performed comparing imipramine, desipramine, amitriptyline, phenelzine and placebo. A global efficacy has been found but the improvement was more closely related to associated symptoms, namely anxiety and depression, than to the core symptoms of PTSD.     

The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma

This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hills-borough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.     

Efficacy of self-administered treatments for depression and anxiety.

Self-administered treatments (SATs) are widely used by the general public and mental health professionals. Previous reviews of the efficacy of SATs have included under this category interventions for nonclinical problems, group interventions, and interventions involving significant amounts of therapist contact. The efficacy of SATs for clinical levels of depression and anxiety with minimal therapeutic contact was examined by meta-analyzing 24 studies. The results show large effects for SATs when compared with no-treatment control groups (d=1.00). However, unlike previous meta-analyses that found nonsignificant differences between SATs and therapist-administered treatments, in this sample SATs resulted in significantly poorer outcomes (d=-0.31). Some differences in effect size were observed between the clinical targets of depression and anxiety. However, there were high correlations between clinical target, methodological quality of the study, and amount of contact. This makes it impossible to determine whether the observed differences could be explained by the nature of the disorders, methodological quality, or the amount of contact with a member of the research team. The implications of the findings for the clinical use of SATs and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

All PTSD symptoms are highly associated with general distress: Ramifications for the dysphoria symptom cluster.

This study used longitudinal data collected from two trauma-exposed samples, survivors of community violence (N = 294) and wildfire evacuees (N = 234), to examine a key claim underlying a proposed reformulation of the symptom structure of posttraumatic stress disorder (PTSD). This theory, which we term the PTSD–dysphoria model, posits that 8 of 17 symptoms of PTSD reflect dysphoria or general psychological distress and might be deemphasized to improve the utility of the PTSD construct (Simms, Watson, & Doebbeling, 2002). For each sample, we analyzed PTSD symptoms and measures of general distress administered at 2 time points. A consistent pattern of findings was observed across assessments for each sample: All 17 PTSD symptoms were highly associated with measures of general distress. Moreover, we found no evidence that dysphoria symptoms were more highly correlated than PTSD-specific symptoms with general distress. Results call into question both the conceptual basis and the clinical utility of differentiating between symptoms that appear to be relatively specific to PTSD and those that seem more broadly characteristic of general psychological distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Longitudinal Study of Retirement in Older Male Veterans.

In this study, the authors examined the effect of retirement on psychological and physical symptoms in 404 older male veterans who were taking part in an ongoing longitudinal study. Hierarchical linear modeling was used to analyze symptom trajectories from preretirement, peri-retirement, and postretirement periods in veterans with either lifetime full or partial posttraumatic stress disorder (PTSD), trauma exposure only, or no traumatic exposure. As expected, the PTSD group experienced greater increases in psychological and physical symptoms during retirement, relative to the other groups. Retirement due to poor health in the PTSD group did not account for the findings regarding physical symptoms. Results indicate that clinicians should recognize and address the potential for older individuals with PTSD to experience difficulties during retirement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beta-blockers in cardiac insufficiency: should they always be considered in the therapeutic strategy? Arguments in favor

Pitman et al. recently published a pair of studies on the relationship between indicators of emotional processing and outcome in flooding therapy (Compr Psychiatry 1996;37:409-416) and eye movement desensitization and reprocessing therapy (EMDR; Compr Psychiatry 1996;37:419-429). Among their conclusions, they asserted EMDR was found to be at least as effective flooding in the treatment of combat-related posttraumatic stress disorder (PTSD) and produced fewer adverse consequences. Although this research constitutes an important contribution to the literature on psychosocial treatments for PTSD, their conclusions regarding the relative effectiveness of these two treatments are unwarranted. The bases of our objections are that (1) assignment of participants to treatment conditions was nonrandom, and (2) several significant procedural differences existed between the two studies in addition to the specific treatments under investigation. These include different inclusion and exclusion criteria, the confounding of psychological treatment with psychiatric medication status, and differences in assessment procedures. Since the two treatments were not compared in a single head-to-head controlled trial, we conclude that their relative efficacy has yet to be investigated.     

Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis.

Objective: It is widely believed that psychological treatment has little effect on more severely depressed patients. This study assessed whether pretreatment severity moderates psychological treatment outcome relative to controls by means of meta-analyses. Method: We included 132 studies (10,134 participants) from a database of studies (www.evidencebasedpsychotherapies.org) in which the effects of psychological treatment on adult outpatients with a depressive disorder or an elevated level of depressive symptoms were compared with a control condition in a randomized controlled trial. Two raters independently extracted outcome data and rated study characteristics. We conducted metaregression analyses assessing whether mean pretreatment depression scores predicted psychological treatment versus control condition posttreatment effect size and subgroup analyses summarizing the results of studies reporting within-study analyses of depression severity and psychological treatment outcome. Results: Psychological treatment was found to be consistently superior to control conditions (d = 0.40–0.88). We found no indication that pretreatment mean depression scores predicted psychological treatment versus control condition posttreatment effect size, even after adjusting for relevant study characteristics. However, among the smaller subset of studies that reported within-study severity analyses, posttreatment effect sizes were higher for high-severity patients (d = 0.63) than for low-severity patients (d = 0.22) when psychological treatment was efficacious relative to a more stringent control. Conclusion: Contrary to conventional wisdom, our findings suggest that when compared with control conditions, psychological treatment might be more efficacious for high-severity than for low-severity patients. Because the number of studies reporting within-study severity analyses is small, we recommend that future studies routinely report tests for Severity × Treatment interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and predictors of posttraumatic stress in women undergoing an ovarian cancer investigation.

This study assessed posttraumatic stress disorder (PTSD) in women being investigated for an ovarian cancer diagnosis to determine prevalence and factors predicting PTSD in these patients. Participants (N = 75) were recruited from the Princess Margaret Hospital in Toronto, Ontario, after their initial clinic appointment and given a prediagnostic assessment that included measures of PTSD, depression, stress and pain. One month later, patients received an identical postdiagnostic assessment. No cases of clinical PTSD were detected, although 13.6% of participants were identified with subsyndromal PTSD. Multiple regression analyses showed that those participants reporting significant baseline depressive symptoms, definitively diagnosed with ovarian cancer, and with shorter treatment wait times were more likely to have a significant increase in PTSD symptoms. Supportive interventions aimed at reducing PTSD symptoms, launched prior to an ovarian cancer diagnosis, might optimally be directed at patients with baseline depressive symptoms and those with shorter treatment wait times. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychophysiology of posttraumatic stress disorder: A meta-analysis.

This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The correlation between two dietary assessments of carotenoid intake and plasma carotenoid concentrations: application of a carotenoid food-composition database

A newly available carotenoid food-composition database providing specific carotenoid values for > 2300 foods was linked to dietary data on 57 male nonsmokers to examine the association between dietary carotenoid intake and plasma carotenoid concentrations over 3 wk when free-living. Carotenoid intake was estimated from a food-frequency questionnaire (FFQ) and 7 d of food diaries with concurrent analysis of plasma carotenoid concentrations. After adjustment for energy intake, percentage of energy from alcohol, and plasma lipid concentrations, significant diet-plasma correlations for the FFQ and the food diaries (FD) included alpha-carotene (r = 0.29 and 0.43), beta-carotene (r = 0.36 FFQ only), beta-cryptoxanthin (r = 0.46 and 0.44), lutein (r = 0.44 FD only), and lycopene (r = 0.53 FD only). Dietary carotenoid intakes were associated with plasma carotenoid concentrations for all the carotenoids except for beta-carotene when food diaries were used whereas the diet-plasma correlation for the provitamin A carotenoids were consistently significant when the FFQ was used.     

Persistent value of intra-arterial fibrinolysis 8 hours or more following central retinal artery occlusion or of its branches

We surveyed more than 1,000 female and male active duty soldiers to assess the effect of premilitary and military trauma on their psychological well-being. Questionnaire data were obtained on pertinent demographic information, history of trauma exposure, and symptoms of post-traumatic stress disorder (PTSD). The results indicated significant gender differences in the types of traumatic events experienced, with females reporting more sexual traumas and males reporting more nonsexual traumas. In addition, males reported experiencing more military-related traumas, whereas females reported experiencing more premilitary traumas. The prevalence of PTSD symptoms was 8.6% for females and 5% for males. Recommendations are presented that may help mitigate development of PTSD symptoms in the future.     

A pilot study of a cognitive restructuring program for treating posttraumatic disorders in adolescents.

The study explored the feasibility and efficacy of a manualized cognitive restructuring program for treating adolescents suffering from posttraumatic stress disorder (PTSD). Nine girls and 3 boys (mean age 16 years; range = 14–18), with PTSD, were recruited from a community mental health center and a tertiary health care center and enrolled in a pilot study. The adolescents were seen weekly for 12–16 weeks of individual treatment. Variables assessed included: trauma history, PTSD diagnosis and severity, depression, substance abuse, and client satisfaction. Twelve adolescents consented to treatment; 9 completed the program. The number of types of traumas reported averaged 6.5 (range = 1–13). Paired t tests were used to test prepost change for PTSD symptoms and depression, in completers. From baseline to posttreatment, there were statistically significant improvements in PTSD and depression. Treatment gains were maintained at 3 month follow-up. Preliminary results suggest the feasibility of implementing a manualized cognitive restructuring program to treat PTSD in adolescents. Completers rated themselves as improved and satisfied at posttreatment and 3-month follow-up. Feedback from referring clinicians also indicated high satisfaction. (PsycINFO Database Record (c) 2011 APA, all rights reserved)